Blessed is he who has found his work; let him ask no other blessedness” wrote Carlyle.1 However, according to a report published last year from the British Society of Rehabilitation Medicine,2 British workers who are injured or ill find it difficult to return to this happy state, and society helps them little in their quest. The report, written by a multidisciplinary working group which explored practices in the NHS, the Employment Service, and industry that impede the return to employment of those with a recent injury, illness, or disability, makes interesting, if sobering, reading.

The need is clear: an average of 3000 British people move on to incapacity benefits weekly, and the social and economic costs of this are enormous (reaching £10bn a year3). The leading causes are familiar to any general practitioner: musculoskeletal injury (28%), psychiatric disorders (20%), and diseases of the circulatory system. Although vocational rehabilitation has been shown to expedite return to meaningful employment, minimise workdays lost, reduce premature retirement, and increase the productivity of injured workers, the authors argue that it has always been neglected in Britain. In addition the system is unwieldy and unresponsive, so that the short, critical window of opportunity for effective rehabilitation may be missed. Thereafter fit workers become physically deconditioned, and typically enter a self perpetuating cycle of hopelessness, anxiety, and depression, and the likelihood of a successful return to work varies …